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      Índices geométricos de variabilidade da frequência cardíaca em crianças obesas e eutróficas Translated title: Geometric indexes of heart rate variability in obese and eutrophic children Translated title: Índices geométricos de variabilidad de la frecuencia cardíaca en niños obesos y eutróficos

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          Abstract

          FUNDAMENTO: Obesidade promove alterações na modulação autonômica cardíaca. OBJETIVO: Investigar a modulação autonômica de crianças obesas e eutróficas por meio de índices de variabilidade da frequência cardíaca (VFC) obtidos por métodos geométricos. MÉTODOS: Foram analisados dados de 133 crianças, com idade entre 8 e 13 anos, divididas em dois grupos: obeso (n = 61) e eutrófico (n = 72), segundo o índice de massa corporal para sexo e idade. Para a análise da VFC, a frequência cardíaca foi captada batimento-a-batimento. Os intervalos RR obtidos foram convertidos em figuras geométricas e, a partir delas, foram calculados o índice triangular (RRtri), interpolação triangular dos intervalos RR (TINN), os índices SD1, SD2 e relação SD1/SD2, obtidos do plot de Poincaré. Análise visual do plot foi também realizada. Realizaram-se o teste t de Student para dados não pareados e o teste de Mann-Whitney, com nível de significância de 5,0%, para análise dos dados. RESULTADOS: Em crianças obesas, foram observadas reduções dos índices RRtri (0,0730 vs 0,1084 [mediana]), TINN (171,80 ± 55,08 vs 218,26 ± 51,12), SD1 (19,93 ± 9,10 vs 24,10 ± 8,03) e SD2 (51,63 ± 16,53 vs 69,78 ± 17,19). A relação SD1/SD2 não apresentou diferenças significantes (0,3781 ± 0,12 vs 0,3467 ± 0,08). A análise visual do plot, em crianças obesas, mostrou menor dispersão dos intervalos RR tanto batimento-a-batimento, como a longo prazo, indicando menor VFC. CONCLUSÃO: Crianças obesas apresentaram modificações no sistema nervoso autônomo, caracterizadas por reduções na atividade parassimpática e na variabilidade global.

          Translated abstract

          BACKGROUND: Obesity causes changes in cardiac autonomic modulation. OBJECTIVE: To investigate the autonomic modulation of eutrophic and obese children by means of indexes of heart rate variability (HRV) obtained through geometric methods. METHODS: We analyzed data from 133 children aged 8 to 13, divided into two groups: obese (n = 61) and eutrophic (n = 72) according to body mass index for age and sex. For the analysis of HRV, heart rate was recorded beat-to-beat. The RR intervals were transformed into geometric figures, and from them, we calculated the triangular index (RRtri), triangular interpolation of RR intervals (TINN), the indexes SD1, SD2 and SD1/SD2 ratio, obtained from the Poincaré plot. Visual analysis of the plot was also performed. Student's t test was performed for unpaired data and Mann-Whitney's test, with significance level of 5.0%, for data analysis. RESULTS: In obese children, RRtri indexes were proven to be reduced (0.0730 vs 0.1084 [median]), TINN (171.80 ± 55.08 vs 218.26 ± 51.12), SD1 (19.93 ± 9.10 vs 24.10 ± 8.03) and SD2 (51.63 ± 16.53 vs 69.78 ± 17.19). The SD1/SD2 ratio showed no significant differences (0.3781 ± 0.12 vs 0.3467 ± 0.08). Visual analysis of the plot, in obese children, revealed a smaller dispersion of RR intervals both beat-to-beat, and in the long term, indicating lower HRV. CONCLUSION: Obese children presented changes in the autonomic nervous system characterized by decreases in parasympathetic activity and overall variability.

          Translated abstract

          FUNDAMENTO: Obesidad promueve alteraciones en la modulación autonómica cardíaca. OBJETIVO: Investigar la modulación autonómica de niños obesos y eutróficos por medio de índices de variabilidad de la frecuencia cardíaca (VFC) obtenidos por métodos geométricos. MÉTODOS: Fueron analizados datos de 133 niños, de edad entre 8 y 13 años, divididos en dos grupos: obeso (n = 61) y eutrófico (n = 72), según el índice de masa corporal para sexo y edad. Para el análisis de la VFC, la frecuencia cardíaca fue captada latido-a-latido. Los intervalos RR obtenidos fueron convertidos en figuras geométricas y, a partir de ellas, fueron calculados el índice triangular (RRtri), interpolación triangular de los intervalos RR (TINN), los índices SD1, SD2 y relación SD1/SD2, obtenidos del plot de Poincaré. Fue también realizado análisis visual del plot . Se realizaron el test t de Student para datos no apareados y el test de Mann-Whitney, con nivel de significancia de 5,0%, para análisis de los datos. RESULTADOS: En niños obesos, fueron observadas reducciones de los índices RRtri (0,0730 vs 0,1084 [media]), TINN (171,80 ± 55,08 vs 218,26 ± 51,12), SD1 (19,93 ± 9,10 vs 24,10 ± 8,03) y SD2 (51,63 ± 16,53 vs 69,78 ± 17,19). La relación SD1/SD2 no presentó diferencias significativas (0,3781 ± 0,12 vs 0,3467 ± 0,08). El análisis visual del plot, en niños obesos, mostró menor dispersión de los intervalos RR tanto latido-a-latido, como a largo plazo, indicando menor VFC. CONCLUSIÓN: Niños obesos presentaron modificaciones en el sistema nervioso autónomo, caracterizadas por reducciones en la actividad parasimpática y en la variabilidad global.

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          Most cited references38

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          New insights into sympathetic regulation of glucose and fat metabolism.

          K Nonogaki (2000)
          The autonomic nervous system modulates glucose and fat metabolism through both direct neural effects and hormonal effects. This review presents recent concepts on the sympathetic regulation of glucose and fat metabolism. Focally released norepinephrine from sympathetic nerves is likely to increase glucose uptake in skeletal muscle and adipose tissues independent of insulin but norepinephrine does not contribute so much as epinephrine to hepatic glucose production. Epinephrine increases hepatic glucose production and inhibits insulin secretion and the glucose uptake by tissues that is induced by insulin. Additionally, catecholamines can increase thermogenesis and lipolysis, leading to increased energy expenditure and decreased fat stores. It is likely that beta-(beta3)-adrenergic receptors mediate these responses. Alterations of central neurotransmission and environmental factors can change the relative contribution of sympathetic outflow to the pancreas, liver, adrenal medulla and adipose tissues, leading to the modulation of glucose and fat metabolism. Recent studies have proposed that leptin, an adipocyte hormone, affects the central nervous system to increase sympathetic outflow independent of feeding. The effects of leptin on glucose and fat metabolism could be in part mediated by the sympathetic nervous system. Studies using mice with a genetic disruption of serotonin 5-HT2c receptor indicate that central neural mechanisms in the regulation of sympathetic outflow and satiety could be dissociated. Abnormalities of sympathetic effects, including disturbances of leptin and beta3-adrenergic receptor signalling, are likely to cause obesity and impaired glucose tolerance in rodents and humans. These findings indicate that dysfunction of the sympathetic nervous system could predispose to obesity and Type II (non-insulin-dependent) diabetes mellitus.
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            Nonlinear systems in medicine.

            Many achievements in medicine have come from applying linear theory to problems. Most current methods of data analysis use linear models, which are based on proportionality between two variables and/or relationships described by linear differential equations. However, nonlinear behavior commonly occurs within human systems due to their complex dynamic nature; this cannot be described adequately by linear models. Nonlinear thinking has grown among physiologists and physicians over the past century, and non-linear system theories are beginning to be applied to assist in interpreting, explaining, and predicting biological phenomena. Chaos theory describes elements manifesting behavior that is extremely sensitive to initial conditions, does not repeat itself and yet is deterministic. Complexity theory goes one step beyond chaos and is attempting to explain complex behavior that emerges within dynamic nonlinear systems. Nonlinear modeling still has not been able to explain all of the complexity present in human systems, and further models still need to be refined and developed. However, nonlinear modeling is helping to explain some system behaviors that linear systems cannot and thus will augment our understanding of the nature of complex dynamic systems within the human body in health and in disease states.
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              Heart rate variability standards of measurement, physiological interpretation, and clinical use

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                abc
                Arquivos Brasileiros de Cardiologia
                Arq. Bras. Cardiol.
                Sociedade Brasileira de Cardiologia - SBC (São Paulo )
                1678-4170
                July 2010
                : 95
                : 1
                : 35-40
                Affiliations
                [1 ] Universidade Estadual Paulista Brazil
                [2 ] Universidade Estadual Paulista Brazil
                [3 ] Faculdade de Medicina de São José do Rio Preto Brazil
                Article
                S0066-782X2010001100006
                10.1590/S0066-782X2010005000082
                958c9555-0375-4c5a-a71e-7599410f744c

                http://creativecommons.org/licenses/by/4.0/

                History
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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0066-782X&lng=en
                Categories
                CARDIAC & CARDIOVASCULAR SYSTEMS

                Cardiovascular Medicine
                Heart rate,child,obesity,body mass index,autonomic nervous system,Frecuencia cardíaca,niño,obesidad,índice de masa corporal,sistema nervioso autónomo,Frequência cardíaca,criança,obesidade,índice de massa corporal,sistema nervoso autônomo

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